H05.319 ICD-10-CM Code: Atrophy of unspecified orbit
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FY 2026 Apr update / Diseases of the eye and adnexa (H00-H59) / Disorders of eyelid, lacrimal system and orbit (H00-H05)
H05.319
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAtrophy of unspecified orbit
This code describes a condition where the eye socket (orbit) on an unspecified side of the face has shrunk or wasted away due to loss of tissue. This can occur from various causes including injury, surgery, or disease affecting the structures within or around the eye socket.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for H05.319 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for H05.319 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for H05.319 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for H05.319 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for H05.319 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for H05.319 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for H05.319 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is H05.319 an HCC code?
No. H05.319 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
H05.319 is the ICD-10-CM diagnosis code for atrophy of unspecified orbit. This code describes a condition where the eye socket (orbit) on an unspecified side of the face has shrunk or wasted away due to loss of tissue. This can occur from various causes including injury, surgery, or disease affecting the structures within or around the eye socket. H05.319 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of eyelid, lacrimal system and orbit (h00-h05).
H05.319 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use the fifth character '9' only when the specific side (right or left) of the orbit is not documented; if laterality is known, use H05.311 (right) or H05.312 (left) instead.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for H05.319 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use the fifth character '9' only when the specific side (right or left) of the orbit is not documented; if laterality is known, use H05.311 (right) or H05.312 (left) instead
- •Atrophy of the orbit is typically a chronic condition that develops over time; ensure documentation supports the diagnosis and consider querying the provider if the affected side is not specified